Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis

Syed Shahzad Hasan, Toby Capstick, Raees Ahmed, Chia Siang Kow, Faizan Mazhar, Hamid A Merchant, Syed Tabish Razi Zaidi

Research output: Contribution to journalReview article

Abstract

Objectives
The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in COVID-19 patients. We systematically reviewed ARDS-associated mortality and the potential role of systemic corticosteroids in COVID-19 patients.

Methods
Electronic databases and country-specific reports were searched to identify relevant studies. The mortality data from these studies were pooled for statistical analysis, and subgroup analysis and quality assessment were performed.

Results
The overall pooled mortality among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI: 23-56%). The pooled mortality for China was 69% (95% CI: 67-72%). In Europe, the highest mortality among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI: 58-86%) while Germany had the lowest mortality (13%; 95% CI: 2-29%). The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile: 13.9%; upper quartile: 53.6%).

Conclusions
The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy including corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.
Original languageEnglish
JournalExpert Review of Respiratory Medicine
Early online date31 Jul 2020
DOIs
Publication statusE-pub ahead of print - 31 Jul 2020

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